[[202210122003 What is CHIME framework]] [[Conceptual framework for personal recovery in mental health systematic review and narrative synthesis]] ## CHIME Framework  The recovery processes that have the most proximal relevance to clinical research and practice are: connectedness; hope and optimism about the future; identity; meaning in life; and empowerment (giving the acronym CHIME). ![[10.1177_20552076221129094-fig1.jpeg]] Source of image from [[Internet-based interventions to support recovery in youth]]]] But what does all these means? Reading this article, [[Understanding everyday life and mental health recovery through CHIME]] , researcher conducted "go-along" with people with SMI in Canada. - "Connectedness refers to relationships, support from others, and community participation; - hope and optimism relate to positive thinking, having dreams and aspirations; - identity includes rebuilding a positive sense of identity and overcoming stigma; - meaning in life takes in quality of life, meanings assigned to the unique experience of mental illness, as well as social roles and goals. - Finally, empowerment assumes a degree of control over life and personal responsibility (Leamy et al., 2011; Bird et al., 2014). ## Connectedness [[202210122004 How to help patients build connectedness]] - Can come from interaction with social community, joining activities group. Coffee shops, gym, interaction with individual not experiencing mental health issues. - From healthcare staff, family, peers. - ==Where do they frequent (locations), who do they interact with regularly?== - Overt Social exclusion - Where are they excluded? Barriers? [[202210122005 Barrier for Connectedness]] ## Hope and Optimism [[202210122007 How to help patients build hope and optimism]] - What plans and hopes they have for their future? - Interactions with healthcare professions: "_healthcare providers instill hope by stressing that tenants are doing well, or noting specific ways in which they have improved either with respect to a personal goal or simply to medication adherence" ==<__--- The language we use is important, even in app design_== [[202210122012 Patients continue struggle with illness dampen hope and optimism]] ## Identity [[202210122021 Patients are not only receiving help, they also can give help]] - Tenants / patients not only receive support, they also are source of support to others. _Being both a source and recipient of support evidences broadening identity dimensions:_ _Social activities and engagement also cultivate facets of personal and social identity beyond those determined by mental illness. Some tenants are involved with and have succeeded in housing facilitated education or employment programs. Others are developing a positive sense of identity  through participation in community-organized sports or arts-based initiatives. [[20210824 What contribute to good therapy outcome]] - Healthcare providers play a central role in helping tenants rebuild and redefine a positive sense of identity. (Michelangelo finding David in the block of marble). [[narrative therapy]] #therapeutic-relationship - Having the diagnosis is like an handicap, and can be overpowering and over shadow the patient's identity. - Perceived and enacted social stigma - How society treats them. _Fred explained things to me as we walked around; for instance, a cafe where he doesn’t like to go because he says people don’t treat him very well there.We went to another café, and the lady serving us only addressed me, not Fred, and then we took a seat, but Fred was very embarrassed. He was seeking  the approval of the waitress to take a seat and he apologized saying “oh no, we’ll only stay until 11:30” […] He confided that after a certain hour, the cafe staff kick him out when he goes to have his water there._ ## Meaning in Life [[202011011428 Problems not about lack of new knowledge but fail to make sense.]] - People are rebuilding their lives in multiple ways. Some participates in activities, go to places that foster wellness. Different tools, some get a pet - Impact of relapses impact rebuilding life, when unwell, cannot participate in social life ## Empowerment [[20220107 My current understanding of treatment rationale and theories]] ![[Polymath#^14b756]] - Control and personal responsibility, over finances for example. strategize when going for shopping. - When they take "lead" for their own treatment. - The issue of waiting!! _However, the issue of “waiting” is both disempowering and a prominent aspect of daily life for tenants. Tenants often wait for hours for appointments, services, and public transport. Waiting presents a material and psychological barrier to empowerment by impacting control over personal schedules and is, at times, a source of exasperation:_ _After getting bloodwork done in another area of the hospital, we […] waited to see his psychiatrist. [W]e got there at exactly 13:00 […] and we were waiting and waiting. And Mario said, “I’m sorry that we have to wait. Welcome to the life of schizophrenia. A lot of waiting, a lot of trying to be patient”._ - ==What if we occupy the "waiting" time to do something else?== - _It is true, I can control and manage my time,  i feel powerless when i am asked to wait!!_ **Waiting creates daily hurdles, psychological impact. Consistently being at the mercy of others' schedules** In contrast, waiting creates daily hurdles to the everyday work of recovery (Davidson et al., 2005), due to its psychological impacts and its role in shaping service accessibility. Waiting on a daily basis for public transit and services impacts productivity, energy levels, and, consequently, quality of life. Further, consistently being at the mercy of others’ schedules can influence feelings of self-worth, given the reminder that social status influences the worth of one’s time. [[202210122027 Recovery process happens in daily life, as patients navigate through socio-spatial environment though interactions with others. It is a non-linear process]] [[202210122028 The therapeutic relationships between clinicians and patients is important in shaping recovery in patient]] [[202210122029 Trust, Open relationships between patients and clinicians important to foster hope and meaning]] **Patients who have recovery mindset seeks out social connections, which add meaning, improve quality of life and cultivate new identity to themselves.** _Tenants actively seek out social connections outside the purview of specifically mental health services, either through community-based activities, or in frequented spaces such as cafes. Activity involvement speaks to tenants’ recovery journeys, insofar as it signals efforts to stay or get socially engaged, add meaning, improve quality of life, and flesh out other facets of identity. This finding stands in contrast to extant research noting the sedentary lifestyles and lack of meaningful social relationships among individuals with SMI (Lipskaya-Velikovsky et al., 2015_). **Social Mobility, the freedom to access spaces and services in the community is important for recovery.** _Beyond tenants’ efforts, conveniently accessible services also foster social connectivity. This finding supports extant work examining the importance of community mobility  (Gardner, 2014) in shaping social engagement or exclusion, as well as the importance of personal control of physical movement in enhancing a sense of community (Royce-Davis, 2001)._ ---